目的 探討七葉洋地黃雙苷滴眼液聯(lián)合雷珠單抗注射液治療滲出型老年性黃斑變性的臨床效果。方法 選取2020年8月—2021年7月湖北省中西醫(yī)結(jié)合醫(yī)院收治的86例（86只眼）滲出型老年性黃斑變性患者，按隨機(jī)數(shù)字表法將86例（86只眼）患者分成對(duì)照組和治療組，每組各43例（各43只眼）。對(duì)照組給予玻璃體內(nèi)注射雷珠單抗注射液，常規(guī)消毒鋪巾并行表面麻醉后，向患者玻璃體內(nèi)垂直進(jìn)針，注射部位在角鞏膜緣后3.5 mm處，劑量為0.5 mg/次，1次/月。治療組在此基礎(chǔ)上于眼結(jié)膜囊內(nèi)滴入七葉洋地黃雙苷滴眼液，1滴/次，3次/d。連續(xù)治療3個(gè)月后觀察兩組臨床療效。比較治療前后兩組最佳矯正視力、眼底情況[黃斑中心凹厚度（CMT）、眼底滲出面積及出血面積、熒光素眼底血管造影（FFA）熒光滲漏面積]、視網(wǎng)膜中央動(dòng)脈血流動(dòng)力學(xué)指標(biāo)[平均血流速度（Vmean）、阻力指數(shù)（RI）、收縮期峰值流速與舒張末期流速比值（S/D）]及血清血管內(nèi)皮生長(zhǎng)因子（VEGF）、血小板衍生生長(zhǎng)因子（PDGF）、內(nèi)皮素1（ET-1）和C反應(yīng)蛋白（CRP）水平。結(jié)果 治療后，治療組總有效率是90.7%，較對(duì)照組的72.1%顯著提高（P<0.05）。兩組治療后最佳矯正視力均顯著提高，CMT、眼底滲出面積及出血面積、FFA熒光滲漏面積均顯著縮?。?i>P<0.05）；但均以治療組改善更顯著（P<0.05）。治療后，兩組視網(wǎng)膜中央動(dòng)脈V_mean均顯著增加，視網(wǎng)膜中央動(dòng)脈RI、S/D均顯著降低（P<0.05）；但均以治療組改善更顯著（P<0.05）。治療后，兩組血清VEGF、PDGF、ET-1和CRP水平均顯著低于治療前（P<0.05）；且治療后，治療組血清VEGF、PDGF、ET-1和CRP均顯著低于對(duì)照組（P<0.05）。結(jié)論 七葉洋地黃雙苷滴眼液聯(lián)合雷珠單抗治療滲出型老年性黃斑變性的總體療效滿意，可安全有效地提高患者視力、促進(jìn)眼底病理改變的改善及改善眼部血供，并能進(jìn)一步抑制血清VEGF、PDGF、ET-1和CRP的水平。

Objective To investigate the clinical effect of Esculin and Digitalisglycosides Eye Drops combined with ranibizumab in treatment of exudative age-related macular degeneration. Methods A total of 86 patients (86 eyes) with exudative age-related macular degeneration who were treated in Hubei Provincial Hospital of Integrated Traditional Chinese and Western Medicine from August 2020 to July 2021 were selected and divided into control group and treatment group with 43 cases in each group (43 eyes in each case) using the random number table method. Patients in the control group were given Ranibizumab Injections. After routine disinfection and surface anesthesia, the injection site was 3.5 mm behind the corneoscleral margin, and the dose was 0.5 mg/time, once monthly. Patients in the treatment group were dropped Esculin and Digitalisglycosides Eye Drops in the conjunctival sac of the eye on the basis of the control group, 1 drop/time, 3 times daily. The clinical efficacy of the two groups was observed after 3 months of continuous treatment. The best corrected visual acuity, fundus conditions[foveal macular thickness (CMT), fundus exudation area and hemorrhage area, fluorescein fundus angiography (FFA) fluorescence leak area], central retinal artery blood flow were compared between the two groups before and after treatment. Fluid dynamics indexes[mean blood flow velocity (V_mean), resistance index (RI), ratio of peak systolic flow velocity to end-diastolic flow velocity (S/D)] and serum vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF)), endothelin-1 (ET-1) and C-reactive protein (CRP) levels. Results After treatment, the total effective rate of the treatment group was 90.7%, which was significantly higher than that of the control group (72.1%, P < 0.05). After treatment, the best corrected visual acuity was significantly improved, and the CMT, fundus exudation area and bleeding area, and FFA fluorescence leakage area were significantly reduced in both groups (P < 0.05). However, the improvement was more significant in the treatment group (P < 0.05). After treatment, the V_mean of central retinal artery was significantly increased, but the RI and S/D of central retinal artery were significantly decreased in both groups (P < 0.05). However, the improvement was more significant in the treatment group (P < 0.05). After treatment, the serum levels of VEGF, PDGF, ET-1, and CRP in the two groups were significantly lower than those before treatment (P < 0.05). After treatment, serum VEGF, PDGF, ET-1, and CRP in the treatment group were significantly lower than those in the control group (P < 0.05). Conclusion Esculin and Digitalisglycosides Eye Drops combined with ranibizumab has satisfactory overall curative effect in treatment of exudative age-related macular degeneration, and can safely and effectively improve the visual acuity of patients, and promote the improvement of fundus pathological changes and improve ocular blood supply, which can further inhibit the levels of serum VEGF, PDGF, ET-1 and CRP.

R988.1

湖北省科技計(jì)劃項(xiàng)目（20191016）